TO DO ALONE

“Flora”, ninety-one, suffers from dementia. Flora lives in an assisted living facility as she needs help with all of her daily needs. Flora is widowed and has two children. Her son, “Ted”, lives locally but not able to visit. Ted suffered a stroke six months ago and was hospitalized for several months. He recently contracted scabies at a nursing facility. He is now homebound; quarantined because of his illness. Before he became sick, Ted and his wife would visit Flora several times each week. In addition, Flora has a daughter, “Leslie”, who lives two states away.

Flora has been in a recent decline to where she is becoming much weaker and eating less. Flora needs to be fed as she has forgotten how to feed herself. She is on a pureed diet as coughs easily when eating solid food. Due to her weakness, Flora spends most of her days in her wheelchair or recliner. Flora no longer talks and does not recognize her family.

Due to Flora’s recent decline, the hospice nurse and I went out to admit Flora to our hospice program. Leslie was able to sign all of the appropriate paperwork and fax it back to our hospice office. I spoke with Leslie on the phone during the admission. It was during that phone call when she shared her mother’s belief about the dying process.

Leslie says it is hard as her mother no longer knows who they are, but then, she would like to visit. I told Leslie to do what her heart dictates. She is in a dilemma as wants to visit; but then wants to do things the way her mother would want her to do things. Leslie feels, that if her mother were aware, she would not want her family to come. Leslie has good support and does reach out to her friends. Leslie also shared that she loves to knit, which gives her comfort.

People die the way they live. No one really knows how much Flora understands. Leslie is trying to do the right thing. I wish all of this family the best. They have had some difficult times recently. I hope all get the support they need.


TO DO ALONE　

You walk in and immediately see her.
Eyes closed, but not sleeping.
Others sitting around, not interacting.
She in her recliner; all alone.

She looks content and comfortable.
She has such a sweet, kind face.
She no longer remembers much;
how to eat; how to dress; how to talk.

Her son lives nearby,
but unable to come around.
Quarantined with an infection.
Isolated in his own home.

Her daughter lives two states away.
She speaks with the staff each day.
Wanting an update on how mom is doing.
Knowing she is in a persistent decline.

She'd like to visit more,
but knows to stay at home
as her mother always told her,
"Dying is something
         you have to do alone."

LIFE'S LOSSES

Ninety-seven year old "Amanda" has been in a recent decline. She has no remarkable health diagnosis, but is just becoming weaker and weary. Where three months ago, she was able to ambulate with her walker, now she is wheelchair bound. Her granddaughter, "Susan", her primary caretaker, states that her grandmother's appetite is half of what it once was. Susan added that, day by day, her grandmother is getting weaker and needing more help.

The hospice nurse and I went out to meet with Susan and Amanda. Amanda was sitting in her bedroom at a table by the window looking outside. She has lost most of her vision and can only see shadows, but stated that she enjoys sitting there. She was so happy for hospice to come as it means she is dying. Amanda is so ready to go. She is tired of living this way; being dependent and in pain. Amanda has arthritis in her hips and knees which causes her pain with any movement.

Amanda will talk about her life and the many losses she has endured. She has outlived two husbands and both of her children. Forty years ago, Susan was scarred from a house fire. Susan said that eight members of the family were in the home that caught fire from a faulty water heater that exploded. Susan's mother and grandfather both died in that fire.

Susan shared that her only family remaining is her grandmother, along with her own daughter and two grandchildren. Susan so understands what a gift life is and how suddenly it can all be taken away. She also understands her grandmother's wish for it all to be over. Amanda kept questioning why she was still here at age ninety-seven. Susan says her grandmother is angry at God, but Amanda feels that once your dead, you are just dead.

Through all of Amanda's sharing of her life and losses, she would easily smile. Amanda had a quick wit and had a great sense of humor. I believe, with this family's history of tragedy, has made the survivors appreciate and cherish life much more. I also believe Amanda's sense of humor might have been a great asset in how she and her granddaughter have coped over the years.

I wish the best for Amanda and her granddaughter. I smile when I think of Amanda. Her legacy is not about loss, but about surviving with grace and humor. There is no better legacy.


LIFE’S LOSSES

She’s had so many losses
in her ninety-seven years.
More than any one person
should ever have to endure.

A water heater explosion
and horrific house fire years ago;
killing her husband and only daughter.
Lifelong scars; some hidden, others not.

Her granddaughter now her caretaker.
Visible scars on her hands and face.
Devoted and dedicated to her grandmother.
Understanding the precious gift of life.

Seven years ago her only son dying from cancer.
She feels it should have been her.
She is now blind, dependent and in pain.
"Why am I living so long like this?"

She has no major disability.
Her body is just wearing out.
In spite of what life has dealt her,
she will easily smile with a quick wit.

One moment, she'll make us all laugh.
The next, she'll question her life.
She wants things to happen quickly.
She is done and ready to go.
Enough of
         life's losses. 

SO ALONE

We received a hospice referral today for “Carl”, a sixty-five year old gentleman suffering from end stage cardiac disease. In addition, Carl suffers from dementia and is confused. He was just released from the hospital and transferred to a Skilled Nursing Facility. Carl has no family or friends. The Public Guardian’s Office manages Carl’s affairs.

The hospice nurse and I went out to admit Carl to hospice. Carl was lying in a single room all alone. He was lying on his side with his eyes open. He appeared much older than his years. He is on a feeding tube and uses oxygen. He did not talk or respond at all when the nurse was examining him.

Carl has a highly contagious infection. The hospice nurse had to put on a gown, gloves and mask in order to go in. Gowning up adds another layer of separation. I stood outside by the doorway watching the nurse to see how or if Carl would respond. He continued to lie there with no reaction at all.

This was a late afternoon admission and I was unable to speak with Carl’s Public Guardian as he was gone for the day. I had so many questions about Carl and his life. Did he wish for his life to end so alone this way? Would he want a loved one by his side? I felt such sadness for him. We are social beings and dying is such an unknown journey as we all only do it once. Does he wish to spend his remaining time alone?

Carl's quality of life is so diminished. Would he want a feeding tube that may prolong his life? Sometimes death is not the worse option. I wish him peace and hope that he finds his perfection when he crosses over to the other side.


SO ALONE
　
He has no family that we are aware.
There are no friends who come and visit.
The Public Guardian’s Office manages things.
He is isolated and so alone.

Did he push his family away?
Is there anyone who really cares?
Was he a loner; a hermit;
did he choose to be so alone?

Now he just lies there with his eyes open.
He doesn’t respond or speak at all.
He has a feeding tube that gives him nourishment;
oxygen to help him breathe.

The nursing staff takes care of his physical needs.
They treat him with compassion and show their concern.
Is he uncomfortable with them fussing about?
Would he rather be just left alone?

There are those of us who like our solitude.
There are those who relish privacy.
Somehow, though, it seems a bit scary,
       when one is dying
              to be so alone.

I hope he can feel our compassion.
I hope he knows that there are many who do care.
I’d like to think he will be surrounded by love
when it is his time to go to the other side;
        to be never again left 
               so alone. 

DAY BY DAY

“Leonard”, eighty-seven, was diagnosed with lung cancer four months ago. The cancer has already spread to his spine. In addition, he suffers from dementia. Leonard lives with “June”, his wife of sixty-four years. They had four sons. Their youngest son died forty-five years ago in a motor vehicle accident.

In addition, their eldest son, “Leonard, Jr”, suffered brain damage from a tractor accident two years before his younger brother‘s death. It was the summer before Leonard, Jr's Senior year in high school. June said that Leonard, Jr, was an amazing baseball player. The New York Yankees were scouting him. The Yankees were willing to wait until he graduated from high school. After the accident, Leonard was in a coma for months. June said there was no rehab in those days so she brought her son home. She cared for her son for years. Leonard now lives nearby in an Assisted Living Center.

Leonard, Sr. was admitted to hospice as he has been in a rapid decline since his new diagnosis of lung cancer. He is eating very little and is very weak. Fortunately for June, her son, “Lou”, lives with her and is available to help. Lou was a chef by trade. A few years ago, Lou was cooking at a charity function. While helping set up, a pallet of food fell against him causing a severe back injury. Due to pain, it is difficult for him to stand up for any length of time. He is now on disability.

In spite of all the tragedy this family has endured, both Lou and June have such positive attitudes toward life. They each look at the love and the faith that they have. While June was sharing all of these losses with me, I would ask her how does she cope with it all. Her answer was always the same, “Day by day.”

June is a prime example of a tough spirit and a soft heart. Her strong faith along with the love of her family is what keeps her going. I admire her spunk and her spirit.


DAY BY DAY

He was diagnosed four months ago.
His decline has been swift.
He’s not eating much at all now.
She knows it won’t be long.

Tragedy has hit two of their sons.
A third is disabled, but able to help.
So many losses during one lifetime.
She says she copes, “Day by day.”

She has an amazing spirit.
Her family is right by her side.
The tough times have made them stronger,
“We are closer now than ever before.”

She has such a strong faith.
She knows he will be with God.
It gives her comfort; it gives her peace;
it helps her cope,
          “Day by day.”